Common Health Outcomes Research Articles

Protracted Impairment of Maternal Metabolic Health in Mouse Dams Following Pregnancy Exposure to a Mixture of Low Dose Endocrine-Disrupting Chemicals, a Pilot Study.

Pregnancy, a period of increased metabolic demands coordinated by fluctuating steroid hormones, is an understudied critical window of disease susceptibility for later-life maternal metabolic health. Epidemiological studies have identified associations between exposures to various endocrine-disrupting chemicals (EDCs) with an increased risk for metabolic syndrome, obesity, and diabetes. Whether such adverse outcomes would be heightened by concurrent exposures to multiple EDCs during pregnancy, consistent with the reality that human exposures are to EDC mixtures, was examined in the current pilot study. Mouse dams were orally exposed to relatively low doses of four EDCs: (atrazine (10 mg/kg), bisphenol-A (50 µg/kg), perfluorooctanoic acid (0.1 mg/kg), 2,3,7,8-tetrachlorodibenzo-p-dioxin (0.036 µg/kg)), or the combination (MIX), from gestational day 7 until birth or for an equivalent 12 days in non-pregnant females. Glucose intolerance, serum lipids, weight, and visceral adiposity were assessed six months later. MIX-exposed dams exhibited hyperglycemia with a persistent elevation in blood glucose two hours after glucose administration in a glucose tolerance test, whereas no such effects were observed in MIX-exposed non-pregnant females. Correspondingly, MIX dams showed elevated serum low-density lipoprotein (LDL). There were no statistically significant differences in weight or visceral adipose; MIX dams showed an average visceral adipose volume to body volume ratio of 0.09, while the vehicle dams had an average ratio of 0.07. Collectively, these findings provide biological plausibility for the epidemiological associations observed between EDC exposures during pregnancy and subsequent maternal metabolic dyshomeostasis, and proof of concept data that highlight the importance of considering complex EDC mixtures based of off common health outcomes, e.g., for increased risk for later-life maternal metabolic effects following pregnancy.

Building sustainable research and data tools and partnerships for a healthy city for all

Abstract Vancouver is located in a temperate rain forest surrounded by mountains and water. Indigenous communities, including the Nations whose homelands the city occupies, have recognized that the abundance of this place can build healthy communities for many generations. But contemporary Vancouver is not a healthy city for all. Since 2014, Vancouver has adopted a Healthy City Strategy, a master social sustainability plan to address inequities in the social determinants of health at a population scale. This includes a number of population health targets and indicators. However, implementation has been slow, with substantive integration of health into policy not yet achieved. With support from the Partnership for Healthy Cities, we have translated the Healthy City Strategy's indicators into an online dashboard, including disaggregated local data. In addition to public accountability, this tool enables data to be a platform for aligning city policy, action and investment toward common health outcomes. In parallel, we are also piloting more community-generated approaches to health data and indicators, with a focus on co-creating health indicators with Indigenous communities. Preliminary results have shown improvement in collaboration across city departments, leading to increased focus on upstream, preventive work. The dashboard is enabling frameworks for funding and working with the social service sector toward common health goals. Engagement efforts have shown the continued importance of a holistic strategy for health that is co-created with community knowledge and priorities. These interventions must be sustained and integrated into ongoing work. The technical work of developing the dashboard contributes to city-wide efforts toward data monitoring and reporting. Data has shown to be an important tool for beginning conversations, but sharing data about health inequities experienced by communities must be matched with an ongoing commitment to engagement and co-creation. Key messages Population health data can be leveraged through interactive tools to better integrate and align city policies, plans and investments to address the social determinants of health. Engaging and co-creating policy with communities supports upstream, preventive action on health inequities.

Prediction Algorithm of Young Students' Physical Health Risk Factors Based on Deep Learning.

Young people's physical and mental health is the foundation of society's overall development and the key to improving people's health quality. Middle school students' physical examinations and monitoring work are a surefire way to ensure their healthy development. Poor vision, dental caries, overweight and obesity, and high blood pressure are the most common adverse health outcomes of students caused by adolescent health risk behavior factors. Researchers have been concerned about the retinal fundus vascular system, which is the only internal vascular system that can be observed in a noninvasive state of the human body. Fundus images contain a wealth of disease-related information. Fundus images have been widely used in the field of medical auxiliary diagnosis because many important systemic diseases of the human body cause specific reactions in the fundus. Aiming to solve the problem of inseparable tiny blood vessels, this paper proposes a model of retinal vessel segmentation based on attention mechanisms. In light of the retinal arteriovenous division of discontinuous challenges, the topological structure of the constraint system along with overcoming the network and topology restrictions is monitored. Finally, simulation experiments were conducted on two publicly available datasets. The findings show that the proposed method is reliable, effective, and accurate in predicting physical health risk factors in adolescent students.

Impact of racism and discrimination on physical and mental health among Aboriginal and Torres Strait islander peoples living in Australia: a systematic scoping review

BackgroundRacism is increasingly recognised as a significant health determinant that contributes to health inequalities. In Australia efforts have been made to bridge the recognised health gap between Aboriginal and Torres Strait Islander people and other Australians. This systematic scoping review aimed to assess, synthesise, and analyse the evidence in Australia about the impacts of racism on the mental and physical health of Aboriginal and Torrens Strait Islander peoples.MethodsA systematic search was conducted to locate Australian studies in English published between 2000 and 2020. Five electronic databases were used: PubMed, CINAHL, Embase, Web of Science and the Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research. The search strategy included a combination of key words related with racism, mental health, physical health and Indigenous people. Data were extracted based on review questions and findings were synthesized in a narrative summary.ResultsOf total 338 searched studies from five databases, 12 studies met the inclusion criteria for narrative synthesis where eight were cross-sectional studies and four prospective cohorts. General mental health and general health perception were the most frequently studied outcomes followed by child behaviour, smoking and substance consumption and specific health conditions. The prevalence of racism varied between 6.9 and 97%. The most common health outcomes associated with racism were general poor mental health and poor general health perception. More specific health outcomes such as anxiety, depression, child behaviour, asthma, increased BMI and smoking were also associated with racism but were analysed by a limited number of studies. Three studies analysed psychological distress, negative mental health, sleeping difficulties and negative perceived mental health according to severity of exposition to racism.ConclusionRacism is associated with negative overall mental and negative general health outcomes among Aboriginal and Torres Strait Islander peoples. Strategies to prevent all forms and sources of racism are necessary to move forward to bridging the health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Further research is needed to understand in more detail the impact of racism from an Aboriginal and Torres Strait Islander definition of health and wellbeing.

A systematic review on lagged associations in climate-health studies.

Lagged associations in climate-health studies have already been ubiquitously acknowledged in recent years. Despite extensive time-series models having proposed accounting for lags, few studies have addressed the question of maximum-lag specification, which could induce considerable deviations of effect estimates. We searched the PubMed and Scopus electronic databases for existing climate-health literature in the English language with a time-series or case-crossover study design published during 2000-2019 to summarize the statistical methodologies and reported lags of associations between climate variables and 14 common causes of morbidity and mortality. We also aggregated the results of the included studies by country and climate zone. The associations between infectious-disease outcomes and temperatures were found to be lagged for ∼1-2 weeks for influenza, 3-6 weeks for diarrhoea, 7-12 weeks for malaria and 6-16 weeks for dengue fever. Meanwhile, the associations between both cardiovascular and respiratory diseases and hot temperatures lasted for <5 days, whereas the associations between cardiovascular diseases and cold temperatures were observed to be 10-20 days. In addition, rainfall showed a 4- to 10-week lagged association with infectious diarrheal diseases, whereas the association could be further delayed to 8-12 weeks for vector-borne diseases. Our findings indicated some general patterns for possible lagged associations between some common health outcomes and climatic exposures, and suggested a necessity for a biologically plausible and reasonable definition of the effect lag in the modelling practices for future environmental epidemiological studies.

Grouping of endocrine disrupting chemicals for mixture risk assessment – Evidence from a rat study

Exposure to mixtures of endocrine disrupting chemicals may contribute to the rising incidence of hormone-related diseases in humans. Real-life mixtures are complex, comprised of chemicals with mixed modes of action, and essential knowledge is often lacking on how to group such chemicals into cumulative assessment groups, which is an essential prerequisite to conduct a chemical mixture risk assessment.We investigated if mixtures of chemicals with diverse endocrine modes of action can cause mixture effects on hormone sensitive endpoints in developing and adult rat offspring after perinatal exposure. Wistar rats were exposed during pregnancy and lactation simultaneously to either bisphenol A and butylparaben (Emix), diethylhexyl phthalate and procymidone (Amix), or a mixture of all four substances (Totalmix). In male offspring, the anogenital distance was significantly reduced and nipple retention increased in animals exposed to Amix and Totalmix, and the mixture effects were well approximated by the dose addition model. The combination of Amix and Emix responded with more marked changes on these and other endocrine-sensitive endpoints than each binary mixture on its own. Sperm counts were reduced by all exposures. These experimental outcomes suggest that the grouping of chemicals for mixture risk assessment should be based on common health outcomes rather than only similar modes or mechanisms of action. Mechanistic-based approaches such as the concept of Adverse Outcome Pathway (AOP) can provide important guidance if both the information on shared target tissues and the information on shared mode/mechanism of action are taken into account.

Do Medical School Textbooks Accurately Represent Public Health Concerns? Addressing Discrepancies between References in Textbooks and the Actual Prevalence of Five Congenital Disorders

The pre‐clinical years of medical school are designed to give future physicians the foundational knowledge essential to practicing medicine. Characteristically, the curriculum explores vital topics such as anatomy, physiology, biochemistry, pharmacology, immunology, and other basic sciences. In addition to learning about the “typical” function in a healthy patient, medical students are also taught “pathological” conditions they may see in their clinical settings to discuss treatment, prevention, and prognosis. Due to lecture hour time restraints, it is not possible to speak in depth about every relevant condition; therefore, courses usually assign textbooks to provide additional information to students outside the classroom. We sought to explore the relationship between the frequency with which certain congenital differences were identified in textbooks used in medical school courses, and the prevalence of those conditions within patient populations in the United States. A sample of allopathic and osteopathic schools were surveyed to compile a list of 121 textbooks used in years one and two of medical school. These books were examined to evaluate the references to five congenital conditions with teratogenic and/or genetic origins: congenital cytomegalovirus (cCMV), Zika virus, fetal alcohol syndrome, spina bifida, and Down syndrome. Frequency of mentions was defined as the presence or absence of the name of each condition determined by both automated and manual searches of the texts. Prevalence rates were taken from the Centers for Disease Control and Prevention (CDC). Our results indicate that the frequency of mentions of the selected conditions do not accurately reflect the prevalence of these conditions in the United States as identified by the CDC. Most surprisingly, congenital cytomegalovirus was one of the least mentioned conditions in the texts, despite cCMV having the highest relative prevalence. Our results indicate that the foundational education that first and second year medical students receive through textbooks may not accurately represent their future patient populations. It is important to increase the representation of common, preventable teratogens in the basic science years of medical education in order to augment general physician awareness, which may translate to better patient education of common prevention techniques and health outcomes.

Bushfire smoke: urgent need for a national health protection strategy.

This research was undertaken with support from the Australian National University College of Health and Medicine, and the assistance of resources from the Centre for Air pollution, energy and health Research (CAR). We used the CAR Data and Analysis Technology platform (https://cardat.github.io) to analyse data

Pragmatic Health Assessment in Early Childhood: The PROMIS® of Developmentally Based Measurement for Pediatric Psychology.

To illustrate the integration of developmental considerations into person-reported outcome (PRO) measurement development for application in early childhood pediatric psychology. Combining the state-of-the-science Patient-Reported Outcome Measurement Information System (PROMIS®) mixed-methods instrument development approach with considerations from developmental measurement science, we developed 12 PROMIS early childhood (PROMIS EC) parent report measures to evaluate common mental, social, and physical health outcomes for ages 1-5. Through this interdisciplinary effort, we identified key considerations for early childhood PROs that enable reliable and valid assessment within the real-world constraints of clinical care settings. Four key considerations are highlighted as key to this process: (a) Engage diverse content experts to identify meaningful and relevant constructs; (b) Balance salient features for early childhood with lifespan coherence of constructs; (c) Emphasize observable features across the typical/atypical spectrum; and (d) Ensure feasibility and relevancy for clinical and research application. Each consideration is discussed using exemplars from the PROMIS EC measurement development process. PROMIS EC provides an illustration of how well-established PRO measures for youth can be adapted for younger children by incorporating developmental considerations. This process and resulting key considerations provide clinicians and researchers in the field of pediatric psychology with guidance for adapting PROs to early childhood, enabling critical continuity in domains of high salience to pediatric psychologists.

Investigating the Associations of Major Depressive Disorder with Various Health Outcomes in the Context of Common Genetic Variants: A Mendelian Randomisation Study

Background: Depression is a leading cause of disability worldwide. The associations between major depressive disorder (MDD) and common health outcomes are well described but the biological mechanisms behind the associations of MDD with various health conditions are poorly understood. Methods: We investigated relationships between MDD and 16 mental and 17 physical traits using summary results of genome-wide association studies for these traits. Genetic correlations were analyzed using LD score regression and causal effects were analyzed using Mendelian randomization. Findings: MDD genetically correlates with a majority of the health-related traits and confers a causal effect on 10 mental traits (neuroticism, insomnia, schizophrenia, subjective well-being, bipolar disorder, autism spectrum disorder, attention deficit/hyperactivity disorder, anorexia nervosa, obsessive-compulsive disorder, and anxiety disorder) and four physical traits (cardiovascular disease, dyslipidemia, asthma, and osteoarthritis). Conversely, major depressive disorder is causally influenced by seven mental traits (neuroticism, insomnia, schizophrenia, subjective well-being, bipolar disorder, autism spectrum disorder, and attention deficit/hyperactivity disorder) and cardiovascular disease. Some key genes may contribute to the relationships of MDD with insomnia and cardiovascular disease. Interpretation: Genetic variation may underline the associations of major depressive disorder with various health outcomes. The study supports a causal role for genetic liability of major depressive disorder on most mental disorders and some physical conditions. Funding Statement: This work was supported by the National Natural Science Foundation of China No 81471364 (to FZ). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Not required.

Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable.

The number of cancer survivors worldwide is growing, with over 15.5 million cancer survivors in the United States alone-a figure expected to double in the coming decades. Cancer survivors face unique health challenges as a result of their cancer diagnosis and the impact of treatments on their physical and mental well-being. For example, cancer survivors often experience declines in physical functioning and quality of life while facing an increased risk of cancer recurrence and all-cause mortality compared with persons without cancer. The 2010 American College of Sports Medicine Roundtable was among the first reports to conclude that cancer survivors could safely engage in enough exercise training to improve physical fitness and restore physical functioning, enhance quality of life, and mitigate cancer-related fatigue. A second Roundtable was convened in 2018 to advance exercise recommendations beyond public health guidelines and toward prescriptive programs specific to cancer type, treatments, and/or outcomes. Overall findings retained the conclusions that exercise training and testing were generally safe for cancer survivors and that every survivor should "avoid inactivity." Enough evidence was available to conclude that specific doses of aerobic, combined aerobic plus resistance training, and/or resistance training could improve common cancer-related health outcomes, including anxiety, depressive symptoms, fatigue, physical functioning, and health-related quality of life. Implications for other outcomes, such as peripheral neuropathy and cognitive functioning, remain uncertain. The proposed recommendations should serve as a guide for the fitness and health care professional working with cancer survivors. More research is needed to fill remaining gaps in knowledge to better serve cancer survivors, as well as fitness and health care professionals, to improve clinical practice.

Effects of oats on gastrointestinal health as assessed by in vitro, animal, and human studies.

Oats are uniquely nutritious, owing to their composition of bioactive compounds, lipids, and β-glucan. Scientific research has established that oats can improve diet quality, reduce cholesterol, regulate satiety, and protect against carcinogenesis in the colon; however, determining the effects of oats on gastrointestinal health and the gut microbiome is a newer, evolving area of research. To better understand the effects of oats on gastrointestinal health in humans, a literature review with predefined search criteria was conducted using the PubMed database and keywords for common gastrointestinal health outcomes. Moreover, to examine the gastrointestinal effects of oats across the scientific spectrum, a similar search strategy was executed to identify animal studies. In vitro studies were identified from the reference lists of human and animal studies. A total of 8 human studies, 19 animal studies, and 5 in vitro studies met the inclusion criteria for this review. The evidence in humans shows beneficial effects of oats on gastrointestinal health, with supportive evidence provided by in vitro and animal studies. The effective dose of oats varies by type, although an amount providing 2.5 to 2.9g of β-glucan per day was shown to decrease fecal pH and alter fecal bacteria. For oat bran, 40 to 100g/d was shown to increase fecal bacterial mass and short-chain fatty acids in humans. Differences in study design, methodology, and type of oats tested make valid comparisons difficult. The identification of best practices for the design of oat studies should be a priority in future research, as the findings will be useful for determining how oats influence specific indices of gastrointestinal health, including the composition of the human gut microbiome.

Using multilevel regression with poststratification to obtain regional health estimates from a Facebook-recruited sample

PurposeWe assess the effectiveness of multilevel regression with poststratification (MRP) as a tool to mitigate selection bias from online surveys of small geographical regions. MethodsWe collected self-reported health information from an Internet-based sample of adults residing within the St. Louis, MO, metropolitan area in 2017. We created Bayesian hierarchical models with three sets of predictor variables for each of six common health behaviors and outcomes, with results poststratified using the American Community Survey to estimate region and ZIP Code Tabulation Area–level prevalence. ResultsWhen comparing MRP estimates with a population-based sample as a reference, we found that adjustment using MRP can reduce bias in prevalence estimates and provide estimates for local area prevalence. 14 of 18 adjusted estimates were closer to the benchmark than the unadjusted estimates and MRP using all three covariate sets resulted in better overall agreement with the benchmark compared with the unadjusted estimates. ConclusionsMRP can improve prevalence estimates from self-selected Internet-based samples, although a nonnegligible amount of bias may remain. Illustrating the utility and limitations of this method will help researchers develop relevant estimates of the local public health burden, helping local health officials better understand and reduce poor health outcomes.

Dietary and physical activity patterns related to cardio-metabolic health among Malaysian adolescents: a systematic review

BackgroundA sedentary lifestyle and an unhealthy diet are major factors in the increasing prevalence of obesity among Malaysian adolescents. The purpose of this systematic review is to compile the evidence from observational and intervention studies among Malaysian adolescents to evaluate the associations between diet and physical activity (PA) as determinants of cardio-metabolic risk factors.MethodsA systematic search of Medline via the PubMed, Science Direct, Cochrane Review and Web of Science databases was conducted for studies on the associations between diet and PA factors and cardio-metabolic risk factors among Malaysian adolescents aged 13–18 years that were published until 31 August 2017. The search results were independently screened and extracted by two reviewers.ResultsFrom over 2,410 references retrieved, 20 full texts articles were screened as potentially relevant. Seventeen (16 cross-sectional and one intervention) met the inclusion criteria for data extraction and analysis. All 17 studies were rated as poor quality and the majority had made insufficient adjustment for confounders. As regards the effect of diet and PA on cardio-metabolic health, the intakes of energy (n = 4) and macronutrients (n = 3) and meal frequency (n = 5) were the most commonly studied dietary factors, while the PA score and level were the most commonly studied PA factors. In addition, BMI and body weight were the most common cardio-metabolic health outcomes. The studies showed that obese and overweight adolescents consume significantly more energy and macronutrients. They are also more likely to skip their daily meals compared to their normal weight peers. In most studies, the direction of the PA effect on body weight was unclear. Some studies found that higher PA is associated with a lower risk of overweight and obesity. However, the associations are often small or inconsistent, with few studies controlling for confounding factors.ConclusionsThis review identified a lack of evidence and well-conducted prospective studies on the effect of diet and PA on cardio-metabolic health of Malaysian adolescents.

Household Food Insecurity Narrows the Sex Gap in Five Adverse Mental Health Outcomes among Canadian Adults.

The sex gap (i.e., the significant difference in an outcome between men and women) in the occurrence of a variety of mental health conditions has been well documented. Household food insecurity has also repeatedly been found to be associated with a variety of poor mental health outcomes. Although both sex and household food insecurity have received attention individually, rarely have they been examined together to explore whether or how these indicators of two social locations interact to impact common mental health outcomes. Using a pooled sample (N = 302,683) of the Canadian Community Health Survey (2005–2012), we test whether sex modifies the relationship between household food insecurity assessed by the Household Food Security Survey Module and five adverse mental health outcomes, controlling for confounding covariates. Although the sex gap was observed among food secure men versus women, males and females reporting any level of food insecurity were equally likely to report adverse mental health outcomes, compared with those reporting food security. Therefore, household food insecurity seems to narrow the sex gap on five adverse mental health outcomes.

Surgeries and Health Outcomes Among Patients With Spina Bifida.

Patients with spina bifida (SB) typically develop serious secondary conditions and undergo surgical procedures related to neurologic disorders, orthopedic abnormalities, bladder and bowel dysfunction, and skin breakdown. In this study, we describe the age distribution of common surgical procedures and health outcomes in patients with SB. Using serial cross-sectional data from the National Spina Bifida Patient Registry (2009-2013; n = 4664), we examined surgical procedures (gastrointestinal, neurologic, orthopedic, skin, urologic, and other) and health outcomes (fecal continence, urinary continence, skin breakdown, and ambulation status) of patients with SB by age and SB type (myelomeningocele and nonmyelomeningocele). All patients who were enrolled had available health outcome data, and 81.5% (n = 3801) of patients had complete surgical procedure data, which totaled 18 891 procedures across their lifetimes. Almost all procedures (91.4%) occurred among participants with myelomeningocele SB. For both types of SB, the distribution of procedures varied by age. The most frequent procedures were neurologic, with approximately half (53%) occurring in patients <1 year of age; orthopedic and urologic procedures followed in frequency but tended to occur at older ages. The health outcomes for patients with myelomeningocele SB revealed lower frequencies of positive health outcomes than those for patients with nonmyelomeningocele SB across all age groups. Overall, the rates of fecal and urinary continence and skin breakdown increased with age whereas the ability to ambulate declined with age. Understanding the surgical procedures and health outcome variations by age and SB type can help clinicians and populations that are affected set expectations regarding the occurrence of these procedures and the outcomes throughout the patients' life spans.

The Use of Deceased Controls in Epidemiologic Research: A Systematic Review

Scholarly debate on the use of deceased controls in epidemiologic research continues. This systematic review examined published epidemiologic research using deceased persons as a control group. A systematic search of 5 major biomedical literature databases (MEDLINE, CINAHL, PsycINFO, Scopus, and EMBASE) was conducted, using variations of the search terms "deceased" and "controls" to identify relevant peer-reviewed journal articles. Information was sought on study design, rationale for using deceased controls, application of theoretical principles of control selection, and discussion of the use of deceased controls. The review identified 134 studies using deceased controls published in English between 1978 and 2015. Common health outcomes under investigation included cancer (n=31; 23.1%), nervous system diseases (n=26; 19.4%), and injury and other external causes (n=22; 16.4%). The majority of studies used deceased controls for comparison with deceased cases (n=95; 70.9%). Investigators rarely presented their rationale for control selection (n=25/134; 18.7%); however, common reasons included comparability of information on exposures, lack of appropriate controls from other sources, and counteracting bias associated with living controls. Comparable accuracy was the most frequently observed principle of control selection (n=92; 68.7%). This review highlights the breadth of research using deceased controls and indicates their appropriateness in studies using deceased cases.

The Effect of Adverse Childhood Experience on Clinical Diagnosis of a Substance Use Disorder: Results of a Nationally Representative Study

ABSTRACTBackground: Substance abuse is one of the most common health outcomes associated with adverse childhood experience, and poses a significant public health threat. Objectives: The purpose of this study is to demonstrate a relationship between adverse childhood experience and a substance use disorder using nationally representative data as well as to test whether religion moderates this relationship. Methods: We conducted a secondary analysis using data from the National Longitudinal Study of Adolescent to Adult Health (n = 11,279). Three types of adverse childhood experiences were considered; physical, emotional, and sexual abuse. Logistic regression was used to determine whether risk for developing an alcohol use, cannabis use, or other drug use disorder in adulthood increased as exposure to multiple types of adverse childhood experiences increased while controlling for prior substance use and other demographic variables that have shown associations with substance use. In addition, religiosity was investigated as a possible moderator of the relationship between adverse childhood experience and substance abuse. Results: The likelihood of developing a substance use disorder later in life increased as the score on the adverse childhood experience index increased. While religiosity did significantly reduce the likelihood of developing a substance use disorder, no moderating effects were observed. Conclusions/importance: This study underscores the long-term consequences of exposure to childhood adversity.

Impact of Secondary Prevention in an Occupational High-Risk Group.

A study of medical outcomes among 6857 elderly construction workers who received an initial and at least one periodic follow-up examination as a result of participating in a medical screening program was undertaken. We compared results from the initial examination to follow-up examinations delivered at least 3 years after the initial examination for the following outcomes: body mass index (BMI); total serum cholesterol; nonhigh-density lipoprotein (non-HDL) cholesterol; hemoglobin A1c, hypertension; current cigarette smoking; and 10-year cardiovascular disease (CVD) risk scores. Statistically significant improvements (P < 0.05) were observed for all measures except BMI. Participation in a periodic medical screening program for elderly construction workers is associated with a favorable impact on common health outcomes. When presented with a program designed for them, blue-collar workers are motivated to seek improvements in their health status.

How unemployment and precarious employment affect the health of young people: A scoping study on social determinants

The impact of unemployment and precarious employment on the health of young people is not well understood. However, according to social causation, higher socio-economic positions and thus better working conditions are beneficial to health in general. We tried to synthesize the results of studies that test this hypothesis in the case of young people. We conducted a scoping study mapping all the academic articles published in the period 2006-2016 in Europe. The literature was searched in PubMed/Medline, Science Direct, Web of Science and Scopus. We identified 1770 studies, of which only 46 met the inclusion criteria. There are more studies that focus on the relationship between unemployment and health than between precarious employment and health (28 and 16, respectively). The vast majority of the studies (44) found support for the social causation hypothesis, the most common health outcomes being mental health disorders, health risk behaviour, poor quality of life and occupational injuries. The causal mechanisms behind this association relied mainly on the life-course perspective, the breadwinner model, and the lack of social and economic benefits provided by standard employment. There is evidence that young people are especially vulnerable to health problems when unemployed or working in precarious conditions. Active labour market and training programmes, inclusive social security measures, improved working conditions and targeted health programmes are important for addressing this vulnerability. Further research should strive to enhance the causal model by including a gender perspective, longitudinal data, more indicators on precariousness and third factor explanations.